Appendix 1: exercise programme for synapse case study.

Management of a gentleman with Parkinsonís using a Pilates programme devised and taught by a physiotherapist.

These exercises formed the basis of Rís programme and were progressed or adapted according to R's needs. During the session, each exercise was done between 5 and 10 times.

i. Breathing exercises and static abdominals.

Starting in the rest position with a small cushion or block under the head. Breathe in to prepare, breathe out and draw lower tummy in. Breathe in to let go.

ii. Chin tucks.

Start in the rest position as above, inhale to prepare, exhale to nod your chin down very slightly, inhale to hold, exhale to relax back to starting position.

iii. Small pelvic tilts.

Start in rest position. Breathe in to prepare, breathe out to draw your lower tummy in, tuck your tailbone under a little, as if you were going to lift your bottom up. Feel a lengthening in your lumbar spine. Breathe out to relax.

iv. Big pelvic tilts

As for iii. But this time tuck your tailbone under, lengthen in your lumbar spine and peel the vertebrae off the floor one at a time until you come up onto your shoulder blades. I.e. in the shoulder bridge position. Keep drawing down under your ribs. Breathe in at the top and then roll back down one vertebra at a time, your bottom coming down last.

v. Big pelvic tilts with arms.

As for iv. But when you get to the top breathe in to raise the arms up towards the ceiling, breathe out to roll your back down through the spine, breathe in to take your arms behind you, breathe out to bring your arms back to the sides of your body.

Small abdominal curl.

Start in rest position. Place the hands behind your head. Breathe in to prepare, breathe out, draw the lower tummy in and lift your head and shoulders off the floor, only a little. Breathe in to lower.

vi. Hip twist/knee drop.

Start in rest position. Breathe in to prepare, breathe out to let the right knee come out to the side to 45 degrees. Breathe in to bring it back in. Make sure the pelvis stays still throughout the movement. Repeat with the left leg.

vii. Side lie clam

Lie on your side with hips and knees bent to about 45 degrees. Make sure your head is comfortable on a small head pad and that your head back and hips are nicely aligned. Breathe in to prepare, breathe out and open the top knee making sure the pelvis stays still. Breathe in to lower.

viii. Scissors, level 1.

Start in rest position. Breathe in to prepare, breathe out and raise the right leg up to table top. Breathe in to lower. Breathe in to raise the left leg up.

ix. Leg stretch, level 1.

Start in rest position. Breathe in to prepare, breathe out to slide the right leg along the floor until it is straight. Breathe in to bring it back. Repeat with left leg.

x. Bugs.

Lie in the rest position. Have both arms up to ceiling, palms facing forwards. Breathe in to prepare, breathe out and stretch the right leg away as you take the left arm behind you. Breathe in to bring the arm and leg back to the starting position. Breathe out to repeat with other side.

xi. Chicken wings.

Start in rest position with arms up to ceiling. Inhale to prepare, exhale to take arms behind. Donít arch lower back and keep ribcage soft. Donít worry if your arms donít reach the floor. Keep shoulder blades anchored down. Exhale to draw down under armpits so shoulders and elbows are bent to 90 degrees and elbows are level with shoulders. Inhale to bring arms back down to the side.

xii. Arm scissors. (lying, standing or sitting)

Float arms forward and up to chest level. Inhale to prepare, exhale to take the right arm above your head and left arm down. Inhale to bring arms back to starting position, level with your chest, exhale to raise left arm and lower right arm. Donít shrug your shoulders up. Keep anchored under the shoulder blades.

xiii. Dumb waiter. Sitting or standing.

Elbows into side, bent to 90 degrees, palms facing up or in. Keep shoulder blades drawn down the back. Inhale to prepare, exhale to rotate arms outwards keeping elbows into side. Inhale to bring arms back to starting position. (Do with both arms at same time)

xiv. Thread the needle.

Start in 4 point kneeling

Inhale to prepare, exhale to thread the needle (left arm) under the armpit, let the right arm bend slightly and slide the back of the left arm along the floor so you get a good stretch. Inhale to take the left arm back to the starting position and then stretch it up behind you and follow gently with your head.

xv. 4 point swimming.

Start in 4 point kneeling as above. Breathe in to prepare, breathe out to stretch the right leg out behind you along the floor and the lift the left arm up in front of you. Keep the back and pelvis as still as possible. Breathe in to bring arm and leg back to the starting position. Breathe out to repeat on the other side.

xvi. Diamond Press.

Make a diamond on the floor with your thumbs and second fingers. Rest the forehead in the diamond.

Inhale to prepare, exhale to float the sternum up off the floor so the head follows. Keep looking down so that the neck stays long. Inhale to hold, exhale to replace head back on diamond.

xvii. Arrow.

Starting positions lying on front with arms by your side, palms facing up. Forehead resting on a small cushion.

Inhale to prepare, exhale to lift sternum and head up off floor, keep looking down so neck stays long, reach finger tips down towards feet. Inhale to hold, exhale to lower.

xviii. Prone swimming.

Lie on your front. Arms out in front of you and forehead resting gently on the floor. Breathe in to prepare, breathe out, draw the lower tummy in and lengthen and lift the right leg and left arm up off the floor about 2". Breathe in to lower. Breathe out to repeat with the other side.

xix. Hamstrings.

Lie on your tummy (on the floor) for this exercise. Forehead resting on the back of the hands. Breathe in to prepare, breathe out and bend the right knee to 90 degrees. Have the gluts activated a little throughout the exercise and imagine you are bending the leg through porridge to give a little resistance. Make sure the hips stay firmly on the floor and keep length in the lower back.

xx. Knee rolls.

Start in rest position, place a small cushion between the knees. Breathe in to prepare, breathe out to gently roll the knees to one side, about 45 degrees, breathe in to bring them back to the center , breathe out to roll them to the other side.

xxi. Arm extension in sitting.

Starting position: sitting on a chair. Arms by side, palms facing backwards. Inhale to prepare, exhale to take arms behind. Inhale to return to starting position. Make sure you keep your elbows soft and initiate the movement from in between the shoulder blades.

xxii. Spine twist/Cossack arms.

Sitting on a chair. Place hand on top of each other in front of your chest. Keep thumbs touching your breast bone so the elbows are lifted out to the side. Breathe in to prepare, breathe out to turn to the right, breathe in to come back in, breathe out to turn to the left, breathe in to return to the center.

xxiii. Side lying arm openings.

Lie on side in exercise viii. Have arms out in front of you palms together. Breathe in to prepare, breathe out to open top arm, taking it behind you and following with your head. Breathe in to bring it back to the starting position.

Acknowledgments:

Thank you to Easy Vigour for kind permission to use their diagrams for this appendix.

For more information on the conditions we treat and services we, or to book an appointment please call
01275 871935 or email us at info@physioandpilatesrehab.co.uk

Pilates

Click here for more information.

Contact us

Call: 01275 871935
Email: info@physioandpilatesrehab.co.uk

Home Visits

We provide a home visit service in Clevedon. Other areas may be available on request.

Neuro Physiotherapy
Neurological Physiotherapy
We specialise in treating people with conditions affecting their brain and spinal cord.

Pilates
Pilates
A complete exercise regime designed to promote good posture, flexibility and controlled breathing, whilst toning muscles to attain a leaner, firmer body. We are specialists in using Pilates with rehabilitation needs.
Oncology
Oncology
We are experienced at providing care and treatment to patients with, or recovering from the effects of cancer.
General Rehabilitation
General Rehabilitation
From aches and sprains and injuries to mobility and balance problems, we are here to help!